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PTSD Checklist for DSM-5 (PCL-5)

PTSD Checklist for DSM-5 (PCL-5)

Description

The PCL-5 is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. The PCL-5 has a variety of purposes, including:

Monitoring symptom change during and after treatment

Screening individuals for PTSD

Making a provisional PTSD diagnosis

The gold standard for diagnosing PTSD is a structured clinical interview such as the Clinician-Administered PTSD Scale (CAPS-5). When necessary, the PCL-5 can be scored to provide a provisional PTSD diagnosis.

Changes from previous PCL for DSM-IV

Several important revisions were made to the PCL in updating it for DSM-5:

PCL for DSM-IV has three versions, PCL-M (military), PCL-C (civilian), and PCL-S (specific), which vary slightly in the instructions and wording of the phrase referring to the index event. PCL-5 is most similar to the PCL-S (specific) version. There are no corresponding PCL-M or PCL-C versions of PCL-5.

Although there is only one version of the PCL-5 items, there are three formats of the PCL-5 measure, including one without a Criterion A component, one with a Criterion A component, and one with the LEC-5 and extended Criterion A component.

The PCL-5 is a 20-item questionnaire, corresponding to the DSM-5 symptom criteria for PTSD. The wording of PCL-5 items reflects both changes to existing symptoms and the addition of new symptoms in DSM-5.

The self-report rating scale is 0-4 for each symptom, reflecting a change from 1-5 in the DSM-IV version. Rating scale descriptors are the same: "Not at all," "A little bit," Moderately," "Quite a bit," and "Extremely."

The change in the rating scale, combined with the increase from 17 to 20 items means that PCL-5 scores are not compatible with PCL for DSM-IV scores and cannot be used interchangeably.

Administration and Scoring

The PCL-5 is a self-report measure that can be completed by patients in a waiting room prior to a session or by participants as part of a research study. It takes approximately 5-10 minutes to complete. The PCL-5 can be administered in one of three formats:

Without Criterion A (brief instructions and items only), which is appropriate when trauma exposure is measured by some other method

With a brief Criterion A assessment

With the revised Life Events Checklist for DSM-5 (LEC-5) and extended Criterion A assessment

Interpretation of the PCL-5 should be made by a clinician. The PCL-5 can be scored in different ways:

A total symptom severity score (range - 0-80) can be obtained by summing the scores for each of the 20 items.

Preliminary validation work is sufficient to make initial cut-point score suggestions, but this information may be subject to change. A PCL-5 cut-point score of 33 appears to be a reasonable value to propose until further psychometric work is available.

Interpretation

Characteristics of a respondent's setting should be considered when using PCL severity scores to make a provisional diagnosis. The goal of assessment also should be considered. A lower cut-point score should be considered when screening or when it is desirable to maximize detection of possible cases. A higher cut-point score should be considered when attempting to make a provisional diagnosis or to minimize false positives.

Measuring Change

Good clinical care requires that clinicians monitor patient progress. Evidence for the PCL for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL for DSM-IV.

Change scores for PCL-5 are currently being determined. It is expected that reliable and clinically meaningful change will be in a similar range.

Sample Item

Item: In the past month, how much were you been bothered by: "Repeated, disturbing, and unwanted memories of the stressful experience?"

Weathers, F., Litz, B., Herman, D., Huska, J., & Keane, T. (October 1993). The PTSD Checklist (PCL): Reliability, Validity, and Diagnostic Utility. Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX. NOTE: Due to some confusion over versions of the PCL for DSM-IV, some of the published papers state that the PCL-C was used in this study, but the authors have confirmed that the PCL-S was the version actually used.

Measure availability: Information on measures is available to everyone. However, the assessment tools themselves can only be distributed to qualified mental health professionals and researchers. We maintain measures developed by affiliated staff of the National Center for PTSD.